Treatment Issues Vol. 11, no. 2

treatment
Guidelines for Treatment
The panel on charge of formulating the guidelines for the treatment of HIV infection, dealt with
the following issues:
* The use of viral load and T-cell count tests.
* When to start treatment and with what.
* Treatment for advanced HIV infection.
* When to stop treatment.
* When and how to change treatment.
* Treatment for acute HIV infection.
* Treatment during pregnancy.
Before starting anti-retroviral therapy, every one should have a complete blood test done, including a chemical profile. The test should include a T-cell count and viral load count. The recommendations about whether or not to start treatment are based on the clinical status of the patient and on the
laboratory tests.
Indications for the Initiation of Antiretroviral Therapy
Clinical Category CD4 + T-Cell Count and Viral Load Recommendation
Symptomatic (AIDS, thrush, Any value Treat
unexplained fever)
Less than 500/mm3 CD4 or
Asymptomatic more than 20,000 copies of Treatment should be offered
HIV RNA by PCR
More than 500/mm3 CD4 and Some experts would offer
Asymptomatic less than 20,000 copies treatment while others would
of HIV RNA by PCR delay therapy and observe
Indications for the Initiation of Antiretroviral Therapy
Once the decision to start antiretroviral therapy has been made, the panel recommends that the
best way to use the currently available drugs is in a combination of at least three agents. Although
the possible combinations are numerous, the panel also established categories according to the
shown efficacy of each combination, taking into account potential side effects and the interactions
between the different drugs.
Preferred Combinations
One Protease Inhibitor & Two Nucleoside Analog.
AZT + ddl
Indinavir (Crixivan) d4T + ddl
Nelfinavir (Viracept) AZT +ddC
Ritonavir (Norvir) d4T + 3TC
AZT + 3TC
Alternate Combinations
1 Non-Nucleoside + 2 Nucleoside Analog.
(Nevira pine) (From the colurm above)
Or
Saquinavir (Invirase) + 2 Nucleosidos Analog.
A combination of just two drugs (e.g. two nucleosides) is not considered optimal. The use of just

one drug (monotherapy), regardless of how strong, is not recommended at all.